If it were my parent...

[In case you are interested, I prepared a brief podcast for "The Famous Abba" for Parshas Shoftim; it's available here. The site also offers a "Shabbos Sheet" available here.]

The scene takes place all the time, in hospitals everywhere. An elderly patient is unconscious, and in danger of imminent death. Only dramatic medical intervention will save the patient's life. The family agonizes over the decision - What would Mom want?

The family consults medical staff, who explain the situation and outline the various options. And then a sympathetic doctor or nurse adds, "If it was my mother, I would..." "This happened with my father, and..."

The medical professionals mean well, of course; they are demonstrating that their advice is grounded in a sincere desire to help. What could be more sincere than their actions for their own parents?

Nonetheless, I fear that this approach is morally wrong.

It is true that medical professionals are more familiar with the treatments and their likely outcomes. And it is certainly true that they have a better medical understanding of what is happening. However: Whatever the doctor or nurse would do for their parents would not be a pure medical decision - it would involve many external factors, from their personal ethical codes to their relationships with their parents to their relationships with the other decision-makers, and so on. In short, this is not medical advice, but in our situation it is being offered with misplaced medical authority.

In the context of a hospital room, at a moment when medical professionals are speaking with authority on the medical situation, that authority is easily transferred to their non-medical advice. It is difficult for distraught families to discern where medical advice ends and non-medical advice begins. To my mind, trading on the respect patients have for their medical knowledge to promote a particular path is inappropriate.

To give an example from another field: If a stock broker were to advise me on my investments by saying, "I would suggest investing in XYZ mutual fund; that's where I've told my mother to invest," that would be inappropriate. Without explaining her mother's portfolio, stage in life, and personality, she would be presenting me with an incomplete picture - while giving it the weight of her authority in investing.

Twice, I've mentioned this problem when speaking to medical groups; each time, my perspective has been met by a mix of nodding heads and immobile heads. My sense is that the non-responsive participants think I'm wrong, but I'm not clear on why. Where is the flaw in my objection?

Purim Torah 5775

Since I've been speaking about death so much lately, here's my contribution to Purim Torah 5775: The Torah's 616th mitzvah, Assisted Suicide:

Vayikra 19:16 warns, “You shall not stand by as the blood of your friend is shed.” From this verse, the Supreme Court of Canada shli”t derives the Torah’s 616th mitzvah: To assist your friend in dying. This active commandment is an aseh haba michlal lav, a command derived from a prohibition: You must not stand by, but rather, you must act.

Writing in Carter v. Canada (Attorney General), 2015 SCC 5, the Supreme Court explained further that prohibitions against helping others to die are misguided, as they cause early death. They wrote, “[T]he prohibition deprives some individuals of life, as it has the effect of forcing some individuals to take their own lives prematurely, for fear that they would be incapable of doing so when they reached the point where suffering was intolerable.” Therefore, the Court concluded, it is better to pledge to assist someone to end his life, so that he will live long enough for you to end it, and not kill himself earlier. [Note: This was not a Purim paragraph; this is part of their actual decision. You can look it up.]

The decision did not come without controversy. Rabbi Moshe L’chaim shli”t argued that the talmudic principle, “We do not sin in order to provide merit for another (Shabbat 4a)” should apply, since the killer here sins (murder) in order to prevent his victim from sinning (suicide). However, an amicus brief filed by the KFMI (Kosher Frozen Meals Industry) contended that assisting others in dying is a time-honoured religious practice, and it should be protected regardless of talmudic logic.

Scholars disagree regarding whether it is appropriate to recite a blessing when assisting at the time of death. Igeret She’ol suggests that m’chayeh hameitim (“He who gives life to the dead”) should be recited, since the assister has lengthened the life of his victim by killing him. In response, Bila haMavet argues that no blessing should be recited; the mitzvah of extending the victim’s life has concluded, and therefore the blessing would not be recited over la’asiyato (preceding the mitzvah), as is required.

There is also considerable disagreement regarding the appropriate punishment for a physician who refuses to assist in ending a life. The Royal College of Physicians and Surgeons of Canada favours lashes, but Gesher haMavet disagrees, because failure to assist is a lav she’ein bo maaseh (a prohibition violated via inaction), and therefore there is no corporal punishment.

Another question arises regarding the proper means of assisting. Per Maavir Yabok, it would be best to minimize one’s assistance by using a shinui (an abnormal action), as well as grama (an action which does not directly cause the result). An example would be to place an obstruction in a breathing tube, then use the back of one’s thumb to push a button which would cause carbon dioxide to vent into the tube (shinui), and then to remove the obstruction from the breathing tube (grama). However, Artscroll’s Laws of Assisting Death contends that use of grama could invalidate the mitzvah.The Artscroll guide prefers direct administration of a poison pill, but it acknowledges some debate regarding the blessing the patient should recite upon the pill.

The Supreme Court of Canada Recognizes a Right to Die

This past Friday, the Supreme Court of Canada ruled that the federal ban on assisting suicide violates the rights of Canadian citizens. As they put it here, "The prohibition on physician‑assisted dying infringes the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice." They ruled that the prohibition is "of no force or effect to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." The Canadian legislature now has twelve months to re-write the law to accommodate the view of the Supreme Court.

This is not the space for a full treatment of this subject (feel free to come to my upcoming talk on the subject at Shaarei Shomayim in Toronto on February 23rd). I will not go into halachah here, other than to say that Jewish law is very clear in forbidding actively ending a patient's life.

In this space, I'd just like to point out a tried and true legal principle: Hard cases make bad law. It would be inhuman and un-Jewish to deny the wishes of people who are suffering without remedy - but crafting legislation to address exceptionally difficult situations will produce laws that endanger the rest of society.

Here are some of the challenges such laws would need to address:
* Will we impose age limits, or will we go the way of Belgium, which permits the death of minors? In the Netherlands, a 17 year old - who cannot be trusted to vote - can override parental  refusal and choose death.

* How will we avoid pressure on patients to choose assisted death? As Margaret Dore, a lawyer in the state of Washington, has testified from her experience with their legalized assisted suicide, the existence of this option leads to subtle and unsubtle pressure upon patients to choose death.

* Who will advise the patient in this matter? Will we ask doctors, who function as the protectors of our healthcare resources, to counsel patients on whether or not to tax those resources? [Indeed, the Royal College of Physicians and Surgeons of Canada notes that doctors must be able to "Appreciate the possibility of conflict inherent in their role as a health advocate for a patient or community with that of manager or gatekeeper".]

* Who will testify as to the patient's wishes, where the patient cannot speak? Paragraph 27 of Quebec's Assisted Suicide bill permits relatives to testify [only minors and members of the healthcare "team" may not do so]. Mind you, our Succession Law will not allow relatives to testify regarding the authenticity of a will, because of conflict of interest... but they could testify that a patient wanted to die?

* Will physicians be compelled to help end lives of patients? As noted by the College of Physicians and Surgeons of Ontario, physicians are not necessarily permitted to refuse to treat on moral or religious grounds.

* Who is going to pay for this - should OHIP (Ontario's provincial health insurance), which doesn't cover routine dental and eye exams, pay for death? [Paragraph 26 of Quebec's Act seems to say that Quebec's provincial health insurance does cover the cost of ending a patient's life.] And if not, then could a suffering person be denied death - a human right, per the Supreme Court - because he couldn't pay for it?

As I said above, we must find a way to help people who are suffering. But in my view, licensing assisted suicide is fraught with so many problems as to make responsible legislation an impossibility.

Physician-Assisted Suicide: A Source Sheet

As I mentioned last week, I will be addressing a group of rabbis on Monday on the topic of Physician-Assisted Suicide, Gd-willing. This is in relation to a proposed bill promoting "terminal palliative sedation" and "medical aid in dying".

Below please find the source sheet I plan to use; I am grateful to those who submitted suggestions in response to my post last week, publicly and by email.

As always when I post a source sheet, I know that the structure of the session will be unintelligible from this page alone. However, you might find the sources themselves interesting, or the bibliography at the end useful.

Physician-Assisted Suicide

R' Mordechai Torczyner – torczyner@torontotorah.com

Introduction

1.   Rabbi J. David Bleich, GodTalk: Should Religion Inform Public Debate? Loyola of L.A. Law Review 29 (1996)

[T]his [religious] line of argument will hardly be regarded as respectable in academic circles, certainly not within legal academic circles. And recognition that this type of advocacy is not respectable becomes a self-fulfilling prophecy. If one regards a certain position as somewhat less than respectable, one does not engage in discourse advocating that position. Failure to engage in that type of conversation confirms its lack of respectability and the wall of separation is thereby reinforced not only as a wall between church and state but as a wall between religion and the public square. Accordingly, religious concerns, even when introduced into the public square, lose their validity. But the converse is also true: Religious concerns presented in public discourse again and again dispel embarrassment and become self-validating. But in order for religion to become present in the public square we must first overcome the reticence from which we all suffer.

Division I       Terminal Palliative Sedation

Division II     Medical Aid in Dying

The Imperative for Palliation

2.   Biblical basis for the imperative to mitigate pain                 Leviticus 19:16, 19:18; Deuteronomy 22:2, 22:3

3.   Maimonides, Commentary to Mishnah Pesachim 4:10

ולא הארכתי לדבר בענין זה אלא מפני ששמעתי וגם פירשו לי ששלמה חבר ספר רפואות שאם חלה אדם באיזו מחלה שהיא פנה אליו ועשה כמו שהוא אומר ומתרפא, וראה חזקיה שלא היו בני אדם בוטחים בד' במחלותיהם אלא על ספר הרפואות, עמד וגנזו. ומלבד אפסות דבר זה ומה שיש בו מן ההזיות, הנה ייחסו לחזקיה ולסיעתו שהודו לו סכלות שאין ליחס דוגמתה אלא לגרועים שבהמון. ולפי דמיונם המשובש והמטופש אם רעב אדם ופנה אל הלחם ואכלו שמתרפא מאותו הצער הגדול בלי ספק, האם נאמר שהסיר בטחונו מד'...

I would not have gone on at length about this but for that which I heard, and they have explained to me, that Solomon composed a book of cures, such that a person who took ill with a particular ailment could turn to the book, do as it said and be healed. Hezekiah saw that people who became ill did not put their faith in Gd, but in the Book of Cures, and so he hid it away.

Aside from the fact that this is wrong and foolish, they have ascribed to Hezekiah and his complicit associates a foolishness which would be inappropriate to ascribe to the lowest of the masses! Per their confused and foolish imagination, one who hungered and ate bread, which would undoubtedly heal his great pain – would we say he had removed his trust in Gd?!...

4.   Talmud, Ketubot 33b

אילמלי נגדוה לחנניה מישאל ועזריה, פלחו לצלמא.

Had the Babylonians whipped Chananiah, Mishael and Azariah, they would have worshipped the idol.

5.   Rabbi Eliezer Waldenberg (20^th century Israel), Tzitz Eliezer 13:87

כל היכא שתכשירי הרפואה הניתנים, הן בצורת כדורים והן בצורת זריקות, נתנים המה ע"י הרופא במטרה כדי להקל מעליו יסוריו הקשים מותר לו לתת לחולה, הגם שמאידך המה מזיקים לו ועלולים גם לקרב יותר את מיתתו, כי נראה שזהו ג"כ בכלל נתינת הרשות שנתנה התורה לרופא לרפאות...

Whether the medical means are pills or injections, so long as they are given by a doctor with the goal of lessening his great suffering, ony may give them to the patient even though they will also harm him and they could bring his death closer. It appears that this is part of the Torah's permission to the physician to heal…

6.   Talmud, Berachot 19b

גדול כבוד הבריות שדוחה [את] לא תעשה שבתורה. ואמאי? לימא אין חכמה ואין תבונה ואין עצה לנגד ד' (משלי כא)! תרגמה רב בר שבא קמיה דרב כהנא בלאו דלא תסור. אחיכו עליה, לאו דלא תסור דאורייתא היא! אמר רב כהנא גברא רבה אמר מילתא לא תחיכו עליה, כל מילי דרבנן אסמכינהו על לאו דלא תסור ומשום כבודו שרו רבנן...

"Dignity is so great that it overrides a biblical prohibition." But why not apply Proverbs 21:30, "There is neither wisdom nor understanding nor counsel opposite Gd!" Rav bar Sheva explained before Rav Kahana: The prohibition here is that of, "Do not stray [from the words of the sages]."

They laughed at Rav bar Sheva; the prohibition of "Do not stray" is itself biblical!

Rav Kahana said: When a great man says something, do not laugh at him. The sages linked all of their words to the prohibition of "Do not stray", and for a person's dignity they permitted violation.

7.   Rabbi Dr. Avraham Sofer Avraham, Nishmat Avraham Orach Chaim 301:11:2

ואמר לי מו"ר הגרי"י נויבירט שליט"א... מסתבר שיהיה מותר לחולה כזה לצאת עם המכשיר בשבת, גם במקום שאין עירוב (אך אינו רה״ר גמורה), אם הוא לובש אותו בשינוי־כגון אם הוא כורך וקושר את חגורת הבד מסביב לרגלו או לידו ותוחב שם את המחט... ואמר לי מו״ר שליט״א שיש משום כבוד הבריות בחולה סוכרת כזה כי ללא היתר כנ״ל לא יוכל אף פעם, כל ימי חייו, לצאת מביתו בשבת. אך הוסיף שההיתר הוא דוקא לשם מצוה...  עוד א״ל מו״ר שליט״א שאדם שלא בא אף פעם לביהכ״נ או לשיעור תורה ידברו עליו וזה גם נקרא משום כבוד הבריות.

Rabbi Yehoshua Neuwirth told me… It is logical to contend that such a patient could go out with the device on Shabbat even without an eruv (in an area which was not a full-fledged public domain), if he would wear it in an unusual way, such as by wrapping and tying the band around his leg or hand and poking the needle into it... And my mentor stated that this is a matter of dignity for such a diabetic, for without this permission he could never, in his entire life, leave his house on Shabbat. He added, though, that this permission is only for a mitzvah… He noted that people would talk about someone who never attended synagogue or Torah classes, and this is also an element of "dignity".

8.   Talmud, Ketubot 104a

סליקא אמתיה דרבי לאיגרא, אמרה: עליוני' מבקשין את רבי והתחתוני' מבקשין את רבי, יהי רצון שיכופו תחתונים את העליונים. כיון דחזאי כמה זימני דעייל לבית הכסא, וחלץ תפילין ומנח להו וקמצטער, אמרה: יהי רצון שיכופו עליונים את התחתונים. ולא הוו שתקי רבנן מלמיבעי רחמי, שקלה כוזא שדייא מאיגרא [לארעא], אישתיקו מרחמי ונח נפשיה דרבי.

Rebbe's maid ascended to the roof and said, "The Heavens request Rebbe and the earthly realm requests Rebbe. May it be Gd's will that the earthly realm should overpower the Heavens!"

When she saw how often Rebbe had to go to the washroom,removing his phylacteries and then putting them back on, and how he was in great pain, she said, "May it be Gd's will that the Heavens should overpower the earthly realm!"

The sages were not silent in their prayers for Gd's mercy, so she took a pitcher of water and threw it from the roof. The praying people paused, and Rebbe passed away.

9.   Rabbeinu Nisim (14^th century Spain) to Talmud, Nedarim 40a

פעמים שצריך לבקש רחמים על החולה שימות כגון שמצטער החולה בחליו הרבה ואי אפשר לו שיחיה.

Sometimes one needs to pray for mercy for the patient to die, such as where the patient is in great pain due to his illness and he cannot live.

10.      Rabbi Shlomo Zalman Auerbach (20^th century Israel), Minchat Shlomo 1:91:24

גם באותה שעה שמבקש ומתפלל לד' שהחולה ימות ג"כ חייב הוא להתעסק בהצלתו ולחלל עליו את השבת אפילו כמה פעמים...

 Also, as one requests and prays to Gd for the patient to die, he is also obligated to involve himself in saving the patient and desecrating Shabbat for him, even many times.

Application: Division I – Terminal Palliative Sedation

11.      Rabbi Dr. Mordechai Halperin, http://98.131.138.124/db/showQ.asp?ID=6936

I wish to receive counsel and guidance regarding my 91-year old mother, who has fractures all along her spine due to osteoporosis. Recently she fell and was bounced around, and since then she has experienced great pains.

The advice of the doctors is to sedate her, to prevent pain. According to the doctors she will not return to walking, or to moving her lower body. She can move her arms [only] lightly. However, she is still lucid. The question: May one go along with the doctor's advice and introduce her into sedation to prevent pain? I understand that this sedation would become a permanent state for the rest of her life.

Response: The discussion is of a lucid woman. Therefore, this depends exclusively upon her desire, and one should ask her directly.

12.      Thomas Aquinas, Summa Theologica

It would seem that nobody may lawfully kill a man in self-defense. For Augustine says to Publicola (Ep. XLVII): "I do not agree with the opinion that one may kill a man lest one be killed by him; unless one be a soldier, exercise a public office, so that one does it not for oneself but for others, having the power to do so, provided it be in keeping with one's person." Now he who kills a man in self-defense, kills him lest he be killed by him. Therefore this would seem to be unlawful.

13.      Rabbi Yaakov Emden (18^th century Germany), Mor uKetziah Orach Chaim 328

אבל יש שבוחרין בספק נפשות כדי להציל עצמן מיסורין קשין כאותן שמוסרין עצמן לחיתוך מפני אבן שבכיס ובגיד וחצץ הכליות הכואב אותן מאד בצער קשה כמוות ר"ל. ולאלה מניחין אותן לעשות כחפצם בלי מוחה, מחמת שכמה פעמים נושעים ונרפאים.

Some choose to endanger their lives in order to avoid great pain, like those who undergo surgery for a kidneystone… which pains them like death. They may do so without protest, for they are often saved and healed.

Moving to Division II: May we actively end a patient's life?

14.      Rabbi Yaakov Tzvi Mecklenberg (19^th century Germany), HaKtav v'haKabbalah Noach 9:5

ומיד האדם. כפל לשון אדם ואיש, גם חבר אליו מלת אחיו. נ"ל כי יש שני אופני רציחה. אם לרעת הנרצח לנקום נקמתו ממנו, או לקחת ממונו וכדומה, אם לטובת הנרצח כשהוא משוקע בצער גדול ויבחר מות מחיים

"From the hand of adam [and from the hand of ish, his brother]" – The Torah doubled the term adam and ish, and also joined the word "brother". Apparently, there are two forms of murder: Harming the victim by avenging one's self upon him, taking his property and the like, or benefiting the victim when he is immersed in great pain and he would choose death over life.

15.      Rabbi Yechiel Michel Epstein (19^th century Poland), Aruch haShulchan Yoreh Deah 339:1

ואף על פי שאנו רואים שמצטער הרבה בגסיסתו וטוב לו המות מ"מ אסור לנו לעשות דבר לקרב מיתתו והעולם ומלואו של הקב"ה וכך רצונו יתברך

Although we see that he is in great pain in his goses state, and it would be better for him to die, still, we are prohibited from doing anything to hasten his death. The world and all in it belong to Gd, and such is His will.

Enabling a patient to take his own life: The opposition

16.      Maimondies, Laws of one who Wounds and Harms 5:1

אסור לאדם לחבול בין בעצמו בין בחבירו, ולא החובל בלבד אלא כל המכה... דרך נציון הרי זה עובר בלא תעשה

One may not wound himself or any other person.

17.      Rabbi David ibn Abi Zimra (15^th century Spain/Israel), Commentary to Maimonides, Laws of Sanhedrin 18:6

שאין נפשו של אדם קניינו אלא קנין הקב"ה שנאמר "הנפשות לי הנה" (יחזקאל י"ח) הילכך לא תועיל הודאתו בדבר שאינו שלו, ומלקות פלגא דמיתה הוא.

A person's life is not his property; it is the property of Gd, as Yechezkel 18:4 says, 'The souls are Mine.' Therefore, one's admission regarding something that is not his cannot be effective. [This is even true if the admission would lead not to death but only to lashes, for] lashes are a partial death.

18.      Rabbi Alvin Reines, Reform Judaism, Bioethics and Abortion, Reform Judaism 37:1

Reform Judaism as a polydoxy is a religion that affirms the ultimate moral right of the individual person to exercise authority over her/himself. Stated in other terms, Reform asserts that every person is the ultimate owner of her/himself with the moral right, consequently, to do with her/his mind or body that which she/he chooses to do…It is evident that a Reform Jew has a moral right to commit suicide.

19.      Rabbi Shlomo Zalman Auerbach (20^th century Israel), Minchat Shlomo 1:91:24

הענין של "חיים" אין לנו שום קנה - מידה כמה למדוד את יוקרם וחשיבותם אפילו לא בתורה ומצוות, שהרי מחללין את השבת גם על זקן חולה מוכה שחין אף על פי שהוא חרש ושוטה גמור, ואינו יכול לעשות שום מצוה וחייו הם רק למשא וסבל גדול על משפחתו וגורם להם ביטול תורה ומצוות, ונוסף לצערם הגדול הרי הם אזלי ומדלדלי... אבל מ"מ הואיל וסוף סוף החיים של המשותקים הם רעים ומרים, וגם יש אשר טוב להם המות מהחיים, לכן בכגון דא מסתבר שאין חייבין לעשות מעשה של נתוח בקום ועשה...

We have no measuring stick for "life", to gauge its value and importance even without Torah and commandments. We violate Shabbat even for an elderly, ill, boils-ridden person, even if he is deaf and mute and entirely insane, and he can perform no commandment, and his life is only a burden and great suffering for his family, and he takes them away from Torah study and other commandments, and in addition to their great pain they are deteriorating… But still, because the lives of people who are entirely paralyzed are bad and bitter, and for some of them death would be better than life, in such a circumstance it is logical to say that there is no obligation to operate…

Enabling a patient to take his own life: Suicide due to pain may be different

20.      Talmud, Avodah Zarah 18a

הביאוהו וכרכוהו בס"ת, והקיפוהו בחבילי זמורות והציתו בהן את האור, והביאו ספוגין של צמר ושראום במים והניחום על לבו, כדי שלא תצא נשמתו מהרה.... אמרו לו תלמידיו... פתח פיך ותכנס [בך] האש! אמר להן: מוטב שיטלנה מי שנתנה ואל יחבל הוא בעצמו. אמר לו קלצטונירי: רבי, אם אני מרבה בשלהבת ונוטל ספוגין של צמר מעל לבך, אתה מביאני לחיי העולם הבא? אמר לו: הן. השבע לי! נשבע לו...

They brought him and wrapped him in a Torah scroll, and bound him with vines and kindled them. They brought wool sponges and soaked them in water and placed them on his heart so that his life would not depart quickly… His students said to him… Open your mouth and let the fire enter! He said to them: Better that the One who gave it take it back, and not that I harm myself.

The executioner said to him: My master! If I were to increase the flame and remove the wool sponges from your heart, would you bring me to the next world? He replied: Yes. [The executioner said:] Swear to me! He swore.

21.      Samuel I 31:3-4

(ג) וַתִּכְבַּד הַמִּלְחָמָה אֶל־שָׁאוּל וַיִּמְצָאֻהוּ הַמּוֹרִים אֲנָשִׁים בַּקָּשֶׁת וַיָּחֶל מְאֹד מֵהַמּוֹרִים: (ד) וַיֹּאמֶר שָׁאוּל לְנֹשֵׂא כֵלָיו שְׁלֹף חַרְבְּךָ וְדָקְרֵנִי בָהּ פֶּן־יָבוֹאוּ הָעֲרֵלִים הָאֵלֶּה וּדְקָרֻנִי וְהִתְעַלְּלוּ־בִי וְלֹא אָבָה נֹשֵׂא כֵלָיו כִּי יָרֵא מְאֹד וַיִּקַּח שָׁאוּל אֶת־הַחֶרֶב וַיִּפֹּל עָלֶיהָ:

And the war turned heavily against Saul, and the archers found him, and he suffered greatly from the archers. And Saul said to his armour-bearer: Unsheathe your sword and stab me with it, lest these uncircumcised ones come, stab me and mock me! But his armour-bearer would not, for he was very afraid. And Saul took the sword and fell on it.

22.      Some of the justifications for Rabbi Chanina ben Tradyon

·         The flames were not directly raised (Rabbi Yisrael Meir Lau, Torah sheb'Al Peh 62)

·         Concern for causing stumbling was overridden (Rabbi Moshe Feinstein, Igrot Moshe Choshen Mishpat 2:74:2)

·         It's not self-wounding (Rabbi Shlomo Luria, Yam shel Shlomo to Bava Kama 8:59)

·         Desecration of Gd's Name (Rabbi Eliezer Waldenberg, Tzitz Eliezer 4:13:2:7)

·         It is matter of choosing a 'better' death (Rabbi Menasheh Klein, Mishneh Halachot 7:287)

23.      Rabbi Moshe Feinstein (20^th century Russia/USA), Igrot Moshe Choshen Mishpat 2:74:2

וגם אפשר שבן נח אינו אסור ברציחה שהוא לטובת הנרצח ושאני בזה האיסור לישראל מהאיסור לבן נח

It is also possible that a Noachide is not prohibited from such murder, for it benefits the victim. In this regard, the prohibition for a Noachide may be different from that of a Jew.

24.      Rabbi J. David Bleich (21^st century USA), Treatment of the Terminally Ill, Tradition 30:3 (1996)

Although Rabbi Chanina would have been required to expend his entire fortune in order to avoid that transgression he was not obliged to accept the greater burden of prolonged suffering entailed by a slow death at the stake.

25.      Rabbi Moshe Tendler and Dr. Fred Rosner, Quality and Sanctity of Life, Tradition 28:1 (1993)

One of us (MDT) has suggested that, as an extra measure of cruelty not mandated by the Emperor or Governor, the Executioner had placed the wads of wet wool and had lowered the flame. "Burning at the stake" had a formal protocol which was not followed by the cruel Executioner. Restoring the flame to its original intensity is not considered an act of hastening death but merely the removal of the extra measure of cruel torture introduced by the Executioner.

26.      Some of the justifications for King Saul

·         Desecration of Gd's Name (Rabbi Yom Tov el-Ashvili, as cited in Weiner, Ye Shall Surely Heal)

·         To save the rescuers (Rabbi Shlomo Luria, Yam shel Shlomo Bava Kama 8:59)

·         To avoid mockery (Rabbi David Kimchi, Commentary to Samuel I 31:4)

27.      Rabbeinu Asher (13^th century Germany/Spain) Commentary to Moed Katan 3:94

היה איבוד מותר לו כדאיתא בבראשית רבה ואך את דמכם לנפשותיכם אדרוש מיד נפשותיכם אדרוש את דמכם יכול אפילו נרדף כשאול תלמוד לומר אך לפיכך לא היה בכלל מאבד עצמו לדעת

Suicide was permitted for him, as seen in a midrash, "'But only, your blood for your lives I will seek; from your lives I will seek your blood.' I might say this even for one who is pursued, like Saul? For this reason it says 'But'." Therefore, he was not within the category of willful suicide.

In sum

·         Division I : Continuous Palliation vs. Terminal Palliation

·         Division II: Active ending of a life vs. Double effect vs. Enabling suicide vs. Escaping pain

"Hard cases make bad law"

28.      Five concerns

·         Slippery slope

·         Pressure on the patient

·         Protecting the laws regarding assault

·         Society's responsibility

·         Who advises the patient?

29.      Deutsche-Welle, Belgium approves assisted suicide for minors, Feb. 13 2014

http://www.dw.de/belgium-approves-assisted-suicide-for-minors/a-17429423

The vote on Thursday by Belgium's House of Representatives removed all age restrictions on the right of the incurably sick to end their lives, a vote that has caused considerable controversy.

30.      John Keown, On Regulating Death, Hastings Center Report (1992)

31.      Jane Parkis and R. Warwick Blood, Suicide and the Media, Crisis: The Journal of Crisis Intervention and Suicide Prevention http://psycnet.apa.org/journals/cri/22/4/146/

Reviews 42 studies concerning the relationship between nonfiction media reporting and portrayal of suicide and actual suicidal behavior and ideation. Studies of nonfiction newspaper, television, and book accounts of reported suicide were examined. Results show an association between nonfictional media portrayal of suicide and actual suicide. The association satisfied sufficiently the criteria of consistency, strength, temporality, specificity, and coherence for it to be deemed causal.

32.      Washington State Medical Association, Pain Management and Care of the Terminal Patient (1992)

Adequate interventions exist to control pain in 90 to 99% of patients.

33.      The Bill in Question

28. The physician must be of the opinion that the patient meets the criteria of Section 26, after, among other things… making sure that the request is being made freely and without any external pressure; making sure that the request is an informed one…

34.      Margaret Dore, Preventing Abuse and Exploitation, ABA Senior Lawyers Division 25:4

I have had two clients whose fathers signed up for the lethal dose. In the first case, one side of the family wanted the father to take the lethal dose, while the other did not. He spent the last months of his life caught in the middle and traumatized over whether or not he should kill himself. My client, his adult daughter, was also traumatized. The father did not take the lethal dose and died a natural death.

In the other case, it's not clear that administration of the lethal dose was voluntary. A man who was present told my client that his father refused to take the lethal dose when it was delivered ("You're not killing me. I'm going to bed"), but then took it the next night when he was high on alcohol. The man who told this to my client later recanted. My client did not want to pursue the matter further.

35.      Succession Law Reform Act (1990) Chapter S.26 Part 12

Where a will is attested by a person to whom or to whose then spouse a beneficial devise, bequest or other disposition or appointment of or affecting property, except charges and directions for payment of debts, is thereby given or made, the devise, bequest or other disposition or appointment is void so far only as it concerns,

(a) the person so attesting;

(b) the spouse; or

(c) a person claiming under either of them,

but the person so attesting is a competent witness to prove the execution of the will or its validity or invalidity. R.S.O. 1990, c. S.26, s. 12 (1).

Bibliography of secondary sources on Jewish Law

English articles

·         Rabbi Y. Breitowitz, Physician-Assisted Suicide, jlaw.com

·         Rabbi Y. Breitowitz, The Right to Die, jlaw.com

·         Rabbi J. David Bleich, Treatment of the Terminally Ill, Tradition 30:3 (1996)

·         Rabbi J. David Bleich, GodTalk:Should Religion Inform Public Debate? 29 Loyola L.A.L.Revi. 1513 (1996)

·         Rabbi J. David Bleich, Life as an intrinsic rather than instrumental good, Law and Medicine 139 (1993)

·         Cohen-Almagor/Shmueli, Can life be evaluated? Theoretical Medicine and Bioethics 21 (2000)

·         J Kunin, Withholding artificial feeding from the severely demented Journal of Medical Ethics 29 (2003)

·         Neeman/Sacks, Euthanasia, The Institute for Jewish Medical Ethics

·         Chaim Povarsky, Is euthanasia permissible under Jewish Law, Jewish Law Report Aug 1994

·         Prof. Steven Resnicoff, Physician-Assisted Suicide Under Jewish Law, jlaw.com

·         R' Zev Schostak, Ethical Guidelines for Treatment of the Dying Elderly, J. of Halacha & Contemporary Society 22

·         R' Tendler/Dr. Rosner, Quality and Sanctity of Life in the Talmud and the Midrash, Tradition 28:1 pg. 18 (1993)

·         R' Yaakov Weiner, Insights on the Treatment of the Terminally Ill, Jerusalem Forum on Medicine and Halacha, #5

Hebrew articles

·         Rabbi Chaim Dovid HaLevi, Techumin II (1981) ניתוק חולה שאפסו סיכוייו לחיות ממכונת הנשמה מלאכותית

·         Rabbi Dr. Mordechai Halperin, Assia (1997), מניעת טיפול בחולה א.ל.ס. והמתת חסד

·         Rabbi Yisroel Meir Lau, Torah sheb'Al Peh 25, רצח מתוך רחמים-המתת חסד

·         Rabbi Dr. Abraham Steinberg, Assia (1978), רצח מתוך רחמים לאור ההלכה

·         Rabbi Moshe Stern, Bishvilei haRefuah 5 (1982), רצח מתוך רחמים או תפילה על חולה אנוש שימות

·         Rabbi Yaakov Weinberger, Dinei Yisrael 7 (1976) רצח מתוך רחמים בהלכה היהודית

Books

·         R' Bleich, R' Brayer, Dr. Rosner, Jewish Bioethics (1980)

·         R' Bleich, Judaism and Healing: Halakhic Perspectives (2002)

·         R' Yaakov Weiner, Ye shall surely heal: Medical Ethics from a Halachic Perspective (1995)